Remote Credentialing Specialist

MCVO Talent Outsourcing Services; Makati; Remote; PHP 420,000 - 540,000; Full time

Benefits offered by this job

Remote work

Flexible schedule

Job summary

MCVO Talent Outsourcing Services is seeking a Credentialing Specialist to support credentialing and recredentialing of healthcare providers with insurance networks and other bodies. This role emphasizes compliance, documentation, and coordination.

You will manage provider enrollment submissions, verify licenses and certifications, maintain accurate data in credentialing systems, and assist with audits while working remotely from the Philippines.

Qualifications

• Five years of administrative experience, preferably in credentialing.
• Associate degree in healthcare administration preferred.
• Experience with CAQH and US payer processes is advantageous.

Responsibilities

• Prepare, submit, and track provider enrollment applications.
• Verify licenses, certifications, and insurance coverage.
• Monitor credentialing timelines for compliance.
• Perform primary source verifications and data entry.
• Assist audits and maintain credentialing records.
• Coordinate with providers, payers, and networks to resolve issues.
• Produce reports on credentialing activities for management.

Skills

Attention to detail

Organizational skills

Communication skills

Multitasking

Teamwork

Education

Associate’s degree in healthcare administration

College or equivalent

Tools

CAQH

Credentialing software

Microsoft Office Suite (Word, Excel, Outlook)

Job description

Job description:

The Credentialing Specialist supports the accurate and timely credentialing and recredentialing of healthcare providers with insurance networks, clearinghouses, and other credentialing bodies. This role involves maintaining compliance, ensuring accurate documentation, and coordinating with insurance networks and other credentialing entities.

Key Responsibilities

Credentialing and Recredentialing Support:

• Preparing, submitting, and tracking provider enrollment applications for insurance networks and credentialing organizations.

• Ensure the accuracy and completeness of provider credentialing documentation, including licenses, certifications, and insurance coverage.

• Monitor and update credentialing timelines, ensuring compliance with deadlines and payer requirements.

Compliance and Documentation:

• Perform primary source verifications as directed, maintaining adherence to regulatory and organizational standards.

• Maintain organized credentialing records and ensure accurate data entry in credentialing software or databases.

• Assist in audits of credentialing files to verify compliance with HIPAA and other regulatory requirements.

Communication and Coordination:

• Act as a liaison with the healthcare providers, and external entities to resolve credentialing-related issues.

• Follow up with providers, payers, and clearinghouses to gather required information or clarify discrepancies.

• Communicate updates on credentialing processes and progress to the management.

Administrative Support:

• Provide support during high-volume credentialing periods, including managing overflow tasks as assigned.

• Prepare reports and summaries of credentialing activities for review by the Credentialing Manager or team.

• Assist in training new team members on credentialing processes and software.

Required Knowledge and Skills:

• Basic knowledge of credentialing processes and healthcare regulations.

• Strong organizational skills with exceptional attention to detail and accuracy.

• Proficiency in credentialing software and Microsoft Office Suite (Word, Excel, Outlook).

• Excellent verbal and written communication skills for interacting with internal and external departments.

• Ability to multitask and work collaboratively in a fast-paced environment.

Additional Requirements

• Education: College or equivalent required; an Associate’s degree in healthcare administration or a related field is preferred.

• Experience:

• At least 5 years of administrative experience, preferably in credentialing.

• Experienced with credentialing software such as CAQH and US payer processes is an advantage.

• Experience in facilities enrollment and hospital privileging preferred

• Attributes: Proactive, team-oriented, and capable of handling sensitive information professionally.

Work Environment

• Remote work

• May require flexibility during high-demand periods to meet deadlines.

Work Location: Remote